High dependency care for children - time to move on

Published in 2014, this document outlines 69 recommendations to improve the management of high dependency care, placing the child and their complete critical care pathway at the focus of service delivery. It's intended for staff, management and commissioners seeking to deliver safe and high quality care for critically ill children.

Key findings

  • Considerable variability exists in the delivery of high dependency care between different Trusts.
  • Many factors contribute to variation: varied definitions of high dependency care, staffing levels, resources, staff training and competence, bed capacity, inconsistent funding models, and poorly described local critical care pathways.
  • Evidence to suggest that not all child admittances to Paediatric Intensive Care Units are necessary.
  • Considerable upskilling of staff is required to efficiently and appropriately care for critically ill children.
  • Good practice examples of how high dependency care can be incorporated into the core business of a Paediatric Critical Care (PCC) network – notably in the South West region of England.


  • The introduction of PCC Operational Delivery Networks would facilitate improvements and formalise pathways, education and training.
  • A three-tier hierarchy system of critical care – basic, intermediate and advanced levels of care.
  • Enhanced staff training.
  • Consistent funding model – to bridge the gap between care delivery in intensive care and other high dependency wards/units.
  • The child and their family at the centre of recommendations, with the goal of providing the best care as close to their home as possible.

Drawn up by a multidisciplinary working group including Association of Paediatric Anaesthetists of Great Britain and Ireland, British Association of General Paediatricians, Faculty of Intensive Care Medicine, Intensive Care Society, Paediatric Intensive Care Society, Royal College of Anaesthetists, Royal College of Nursing, Royal College of Paediatrics and Child Health, WellChild and NHS England representatives.